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Background: COVID‐19 necessitated emergency telepractice for student‐led speech‐language therapy clinical practicals in training institutions, with limited preparation and evidence‐based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. Aims: Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student‐led telepractice sessions in a diverse, resource‐limited context. The broader goal of this project was to provide evidence‐based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. Methods & Procedures: We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student‐led paediatric telepractice sessions from a South African university clinic as part of a pilot study. Outcomes & Results: We identified four overarching considerations for student‐led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face‐to‐face contact. Conclusions & Implications: Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice. WHAT THIS PAPER ADDS: What is already known on this subject: Many speech‐language therapy (SLT) student clinicians had to transition quickly to telepractice service provision during COVID‐19 with limited existing guidelines and support, especially in contexts where teletherapy is typically non‐existent or difficult to access. Although there is some literature available on experiences of telepractice, there is very little evidence‐based research which explores the mechanics of such sessions in real‐time and which offers practical support to student clinicians and clinical educators engaging in this mode of service delivery. What this study adds: This pilot study examined video‐recorded, student‐led, paediatric, speech‐language teletherapy sessions to understand challenges and considerations involved in using telepractice as a clinical training tool. Findings show that additional preparation for telepractice sessions is required, particularly in contexts of poor digital literacy; students must learn to manage technology, especially when connectivity poses a challenge, and adapt therapy tasks for online work with clients; telepractice relies heavily on caregiver input and collaboration, more so than in in‐person consultations, and this relationship requires careful management; and promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical yet challenging skills in telepractice. What are the potential or actual clinical implications of this work?: Our findings highlight a need to teach telepractice pedagogy explicitly and support students practically in learning how to provide therapy effectively via this mode of service delivery. Observational methods for studying practices in recorded telepractice sessions can be used as part of a reflective approach to clinical training. Using already available data allowed us to unpack the 'messy reality' of clinical training using telepractice. [ABSTRACT FROM AUTHOR]

Background: The Successful Aging after Elective Surgery (SAGES) II study was designed to increase knowledge of the pathophysiology and linkages between delirium and dementia. We examine novel biomarkers potentially associated with delirium, including inflammation, Alzheimer's disease (AD) pathology and neurodegeneration, neuroimaging markers, and neurophysiologic markers. The goal of this paper is to describe the study design and methods for the SAGES II study. Methods: The SAGES II study is a 5‐year prospective observational study of 400–420 community dwelling persons, aged 65 years and older, assessed prior to scheduled surgery and followed daily throughout hospitalization to observe for development of delirium and other clinical outcomes. Delirium is measured with the Confusion Assessment Method (CAM), long form, after cognitive testing. Cognitive function is measured with a detailed neuropsychologic test battery, summarized as a weighted composite, the General Cognitive Performance (GCP) score. Other key measures include magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS)/electroencephalography (EEG), and Amyloid positron emission tomography (PET) imaging. We describe the eligibility criteria, enrollment flow, timing of assessments, and variables collected at baseline and during repeated assessments at 1, 2, 6, 12, and 18 months. Results: This study describes the hospital and surgery‐related variables, delirium, long‐term cognitive decline, clinical outcomes, and novel biomarkers. In inter‐rater reliability assessments, the CAM ratings (weighted kappa = 0.91, 95% confidence interval, CI = 0.74–1.0) in 50 paired assessments and GCP ratings (weighted kappa = 0.99, 95% CI 0.94–1.0) in 25 paired assessments. We describe procedures for data quality assurance and Covid‐19 adaptations. Conclusions: This complex study presents an innovative effort to advance our understanding of the inter‐relationship between delirium and dementia via novel biomarkers, collected in the context of major surgery in older adults. Strengths include the integration of MRI, TMS/EEG, PET modalities, and high‐quality longitudinal data. [ABSTRACT FROM AUTHOR]

Introduction: The advent of the COVID‐19 pandemic necessitated the Botswana Presidential Task Force, in collaboration with the Ministry of Health and Wellness (MoHW), to devise strategies to utilize the already overburdened health personnel to combat the spread of the coronavirus. This descriptive case study aimed to describe nurses' role during COVID‐19 in Botswana. Design and methods: A case study analysis was used to describe nurses' roles during COVID‐19. Data were collected through observing events in various health facilities and various media platforms that described how nurses had to position themselves to combat the pandemic. Content analysis was done by coding and developing categories that put like content together and generate thematic areas. Results: Nurses from different sectors were redeployed to assist in setting up different units at the COVID‐19 makeshift hospital, taking away from the already understaffed section of health care workers resulting in the overburden and work overload. Furthermore, nurses continued with their regular day‐to‐day nursing care duties in various healthcare settings, albeit under a severe shortage due to the national response to COVID‐19. Conclusion: Adaptations and experiential strategies enabled the distribution of the nursing workforce to cover all locations to curb the spread of COVID‐19 despite the challenges encountered. Recommendations and lessons learned on how to prepare for future pandemics are also discussed. Clinical relevance: Due to their large numbers, nurses formed the backbone of the Botswana COVID‐19 response strategy. Therefore, policy‐makers should be responsive to the nurses' perspectives when developing strategic policies on how to deal with pandemics based on their experiences. [ABSTRACT FROM AUTHOR]

Background: Azvudine (FNC) is a novel small molecule antiviral drug for treating COVID‐19 that is available only on the Chinese market. Despite being recommended for treating COVID‐19 by the Chinese guidelines, its efficacy and safety are still unclear. This study aimed to evaluate the protective effect of FNC on COVID‐19 outcomes and its safety. Methods: We followed the PRISMA 2020 guidelines and searched the PubMed, Embase, Web of Science, Scopus, and China National Knowledge Infrastructure (CNKI) databases to evaluate studies on the effectiveness of FNC in treating COVID‐19 in China, focusing on mortality and overall outcomes. Additionally, its impact on the length of hospital stay (LOHS), time to first nucleic acid negative conversion (T‐FNANC), and adverse events was evaluated. The inclusion criterion was that the studies were published from July 2021 to April 10, 2024. This study uses the ROBINS‐I tool to assess bias risk and employs the GRADE approach to evaluate the certainty of the evidence. Results: The meta‐analysis included 24 retrospective studies involving a total of 11 830 patients. Low‐certainty evidence revealed no significant difference in mortality (OR = 0.91, 95% CI: 0.76–1.08) or LOHS (WMD = −0.24, 95% CI: −0.83 to 0.35) between FNC and Paxlovid in COVID‐19 patients. Low‐certainty evidence shows that the T‐FNANC was longer (WMD = 1.95, 95% CI: 0.36–3.53). Compared with the Paxlovid group, low‐certainty evidence shows the FNC group exhibited a worse composite outcome (OR = 0.77, 95% CI: 0.63–0.95) and fewer adverse events (OR = 0.63, 95% CI: 0.46–0.85). Compared with supportive treatment, low certainty shows FNC significantly reduced the mortality rate in COVID‐19 patients (OR = 0.61, 95% CI: 0.51–0.74) and decreased the composite outcome (OR = 0.67, 95% CI: 0.50–0.91), and very low certainty evidence shows significantly decreased the T‐FNANC (WMD = −4.62, 95% CI: −8.08 to −1.15). However, in very low certainty, there was no significant difference in LOHS (WMD = −0.70, 95% CI: −3.32 to 1.91) or adverse events (OR = 1.97, 95% CI: 0.48–8.17). Conclusions: FNC appears to be a safe and potentially effective treatment for COVID‐19 in China, but further research with larger, high‐quality studies is necessary to confirm these findings. Due to the certainty of the evidence and the specific context of the studies conducted in China, caution should be exercised when considering whether the results are applicable worldwide. Trial Registration: PROSPERO number: CRD42024520565 [ABSTRACT FROM AUTHOR]

Aim: To examine the overall level of self‐assessed competence of final‐year nursing 'bachelors' degree students in the Czech Republic. In addition, the study aimed at the factors associated with the students' level of competence. Design: A cross‐sectional observational study. Methods: Data were collected with the Czech version of the Nurse Competence Scale from 274 final‐year nursing students of the bachelor's nursing program. Data were analysed using descriptive statistics and multiple regression analyses. Results: Majority of the students (80.3%) assessed their level of competence as good or very good. The highest level of competence was assessed in the category of 'managing situations' (VAS mean 67.8) and 'work role' (VAS mean 67.2). Previous work experience in healthcare and successful supervisory experience had a positive association with self‐assessed competence. Students who completed clinical placement during the COVID‐19 pandemic assessed their level of competence as lower than students before the pandemic. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Aim: The aim of this retrospective observational study was to describe the scope of physiotherapy, the population and the physiotherapy management of Covid‐19 patients referred to physiotherapy at a university hospital in the period from March 2020 to July 2021. Method: A descriptive observational study with access to data from a quality register, which contains clinical data of all patients admitted with Covid‐19 to a university hospital in Norway. Data was obtained from electronic data sheets, where daily parameters for physiotherapy treatment were registered. Results: In total, 729 Covid‐19 patients were admitted during this period. Of these, 507 (69.6%) received treatment by a physiotherapist (3510 sessions). The physiotherapy treatments were performed on intensive care units (ICU) (50%), intermediate care units (11%) and general medical units (39%), respectively. Patients were mainly treated during the day (98.5%) and 21% of the sessions were given on weekends or holidays. Within the 3510 sessions, 9459 interventions were performed in total (one to seven interventions per session). The most common intervention provided was positioning (35.4%). The most common interventions in medical units and intermediate care units were training with a positive expiratory pressure device (17.3% and 15.9% respectively), and techniques for reducing work of breathing (13% and 15% respectively). The most common intervention in the ICUs was passive mobilization (21.3%), mostly in combination with positioning, manual techniques and/or airway clearance. Conclusion: This study provides characteristics of, and experiences with early physiotherapy, in sequentially hospitalized patients at a university hospital in Norway. [ABSTRACT FROM AUTHOR]

Introduction: COVID‐19 usually presents with upper respiratory tract infection in varying severity which can lead to sepsis. Early prediction of sepsis may reduce mortality by timely interventions. The intended purpose of this study was to determine whether the advanced parameters like the extended inflammation parameters (EIPs) can predict prognosis and early progression to sepsis as a sequel of COVID‐19 infection and can be used as a screening profile. Also, to evaluate the Intensive Care Infection Score (ICIS) and the COVID‐19 prognostic score and validate the scores for our population. Methods: Prospective observational study of 50 reverse transcription‐ polymerase chain reaction (RT‐PCR) proven admitted COVID‐19 patients. The data assessed included complete blood counts (CBC) with EIP measurements, from Day 1 of admission to Day 10. The following groups were studied: noncritical (NC) and critical illness (CI) in COVID‐19 positive cases, COVID negative sepsis and nonsepsis cases, and healthy volunteers for reference range. Results: The parameters that showed statistically significant higher mean in CI group compared to the NC group are reactive lymphocyte number and percentage (RE‐LYMPH#, RE‐LYMPH%), antibody synthesizing lymphocyte number and percentage (AS‐LYMPH#, AS‐LYMPH%), Reactive monocyte count and percentage (RE‐MONO#, RE‐MONO%/M), ICIS, COVID‐19 prognostic score (p‐value <0.05). The AUC confirmed the diagnostic accuracy of all these parameters. From the multivariate logistic regression, the significant risk factor was RE‐LYMPH# with cut‐off >0.10 (p value: 0.011). Conclusion: The new EIP parameters, RE‐MONO#, RE‐MONO%/M, ICIS score and COVID‐19 prognostic score are useful for early prediction of critical illness. AS‐LYMPH is the most useful predictor of critical illness on multivariate analysis. RE‐MONO# and RE‐MONO%/M parameter are useful in distinguishing critical and noncritical non‐COVID and COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Background: Since the beginning of the coronavirus disease 2019 (COVID‐19) outbreak, the Critical Care Outreach Team (CCOT) remained operational to provide critical care support to acutely ill and deteriorating patients on the wards. Aim: We aimed to evaluate the demand and efficacy of the critical care outreach service during the COVID‐19 pandemic. Method: We prospectively evaluated all patients referred to critical care outreach enrolled during a twelve‐month period. We reported the cumulative number of activities and interventions and baseline characteristics, acuity level and patients' clinical outcome. The rate of ICU admissions, activity plan, patients' acuity and mortality are compared to historical data pre‐pandemic. Results: Amongst 4849 patients referred, 3913 had a clinical review and of those 895 were COVID‐19 positive. Non‐invasive ventilation was mostly delivered to COVID‐19 patients (COVID‐19 +VE: 853/895, 95% vs. COVID‐19 −VE: 119/3018, 4%) alongside awake prone positioning (COVID‐19 +VE: 232/895, 26% vs. COVID‐19 −VE: 0/3018, 0%). Compared to pre‐pandemic, the cumulative number of patients assessed increased (observed: 3913 vs. historical: 3615; p = 0.204), patients meeting Level 2 acuity were higher (observed: 51% vs. historical: 21%; p = 0.003), but ICU admission rate did not increase significantly (observed: 12% vs. historical: 9%; p = 0.065), and greater mortality rate (observed: 14% vs. historical: 8%; p = 0.046) was observed. Conclusion: Critical care outreach bridges the gap between the intensive care unit and general wards and supports the concept of 'critical care without walls' acting as a valuable resource in optimizing and triaging acutely unwell patients and potentially averting critical care admissions. Relevance to Clinical Practice: The COVID‐19 pandemic has generated an unprecedented surge of deteriorating and critically ill patients with has caused severe and sustained pressures on intensive care units (ICUs) and general wards. Acutely ill patients can deteriorate quickly, and early recognition is vital to commence critical intervention on the wards or transfer timely to ICU. The Critical Care Outreach Team can help staff and optimize acutely ill and deteriorating patients by providing timely critical care interventions at the patient bedside. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic has spread globally and caused a major worldwide health crisis. Patients who are affected more seriously by COVID‐19 usually deteriorate rapidly and need further intensive care. Aim: We aimed to assess the performance of the National Early Warning Score 2 (NEWS2) as a risk stratification tool to discriminate newly admitted patients with COVID‐19 at risk of serious events. Design: We conducted a retrospective single‐centre case‐control study on 200 unselected patients consecutively admitted in March 2020 in a public general hospital in Wuhan, China. Methods: The following serious events were considered: mortality, unplanned intensive care unit (ICU) admission, and non‐invasive ventilation treatment. Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to quantify the association between outcomes and NEWS2. Results: There were 12 patients (6.0%) who had serious events, where 7 patients (3.5%) experienced unplanned ICU admissions. The area under the ROC curve (AUROC) and cut‐off of NEWS2 for the composite outcome were 0.83 and 3, respectively. For patients with NEWS2 ≥ 4, the odds of being at risk for serious events was 16.4 (AUROC = 0.74), while for patients with NEWS2 ≥ 7, the odds of being at risk for serious events was 18.2 (AUROC = 0.71). Conclusions: NEWS2 has an appropriate ability to triage newly admitted patients with COVID‐19 into three levels of risk: low risk (NEWS2 = 0‐3), medium risk (NEWS2 = 4‐6), and high risk (NEWS2 ≥ 7). Relevance to clinical practice: Using NEWS2 may help nurses in early identification of at‐risk COVID‐19 patients and clinical nursing decision‐making. Using NEWS2 to triage new patients with COVID‐19 may help nurses provide more appropriate level of care and medical resources allocation for patients safety. [ABSTRACT FROM AUTHOR]

Objectives: To determine the real‐world outcomes associated with using the GetaKit.ca website to distribute COVID self‐tests to persons with risk factors, with a focus on facilitating testing for persons who are Black, Indigenous, or of Colour (BIPOC). Methods: GetaKit was an open cohort observational study to distribute free self‐tests, starting with HIV self‐testings and then adding the Lucira Check‐It® COVID self‐test. Participants would register on our website and complete a risk assessment, which would calculate their need for each type of testing. Results: Focusing on the COVID self‐tests, from September to December 2021 (with targeted outreach in winter 2022), we distributed 6474 COVID self‐tests to 3653 persons through 4161 unique orders, of which 47% came from BIPOC participants. Compared to white participants, BIPOC participants were more likely to have been a contact of COVID but less likely to be vaccinated. As well, 69% of results were reported back via the GetaKit.ca website, with 5.3% of these being positive. The positivity rate for our 3653 participants was 9.6%. Conclusions: Delivering COVID self‐tests via our website provided tests to BIPOC communities and yielded positivity rates that matched local COVID testing centres. This highlights the utility of such systems for delivering testing during future pandemics. [ABSTRACT FROM AUTHOR]

BACKGROUND: We examined fidelity and feasibility of implementation of COVID‐19 preventive measures in schools, and explored associations between adherence to these measures and staff well‐being, to inform policy on sustainable implementation and staff wellbeing. METHODS: Surveys were conducted across 128 schools in England with 107 headteachers and 2698 staff‐members with reference to autumn term 2020, examining school‐level implementation of preventive measures, adherence, and teacher burnout (response rates for headteacher and staff surveys were 84% and 59%, respectively). RESULTS: The median number of measures implemented in primary and secondary schools was 33 (range 23‐41), and 32 (range 22‐40), respectively; most measures presented challenges. No differences were found regarding number of measures implemented by school‐level socio‐economic disadvantage. High adherence was reported for staff wearing face‐coverings, staff regularly washing their hands, (secondary only) desks facing forwards, and (primary only) increased cleaning of surfaces and student hand‐washing. Adherence to most measures was reported as higher in primary than secondary schools. Over half of school leaders and 42% (517/1234) of other teaching staff suffered from high emotional exhaustion. Higher teacher‐reported school‐wide adherence with measures was consistently associated with lower burnout for leaders and other teaching staff. CONCLUSIONS: Findings indicate a tremendous effort in implementing preventive measures and an urgent need to support investments in improving teacher wellbeing. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has affected millions and resulted in a considerable strain on healthcare systems around the world. Intensive care units (ICUs) are reported to be affected the most because significant percentage of ICU patients requires respiratory support through mechanical ventilation (MV). Aim: This study aims to examine the staffing levels and compliance with a ventilator care bundle in a single city in Pakistan. Methods: A cross‐sectional survey of 14 ICUs including medical and surgical ICUs was conducted through a self‐structured questionnaire including a standardized ventilator care bundle. We assessed the compliance of ICU staff to ventilator care bundle and calculated the correlation between staffing patterns with compliance to this bundle. Results: The unit response rate was 64% (7/11 hospitals). Across these seven hospitals, there were 14 functional ICUs (7 surgical and 7 medical). The Mean (SD) numbers of beds and ventilators were 8.14 (3.39) and 5.78 (3.68) while the average patient‐to‐nurse and patient‐to‐doctor ratio was 3: 1 and 5:1 respectively. The median ventilator care bundle compliance score was 26 (IQR = 21–28) out of 30, while in medical and surgical ICUs, median scores were 24 (IQR = 19–26) and 28 (IQR = 23–30) respectively. The perceived least compliant component was head elevation in ventilated patients. Correlation analysis revealed that 24 h a day, 7 days a week onsite cover of Advanced Cardiovascular Life Support certified staff was positively correlated with the ventilator care bundle score (rs = 0.654, p value =.011). Similarly, 24‐h cover of senior ICU nurses was significantly correlated with the application of chlorhexidine oral care (rs = 0.676, p value =.008) while routine subglottic aspiration was correlated with the number of doctors (rs = 0.636, p value =.014). Conclusion: Our study suggests that ICUs in Peshawar are not well staffed in comparison with international standards and the compliance of ICUs with the ventilator care bundle is suboptimal. We found only a few aspects of ventilator care bundle compliance were related to nursing and medical staffing levels. Relevance to clinical practice: Critical care staffs at most of the medical ICUs in Peshawar are not compliant with the standard guidelines for patients on mechanical ventilation. Moreover, the staffing levels at these ICUs are not in accordance with international standards. However, this study suggests that staffing levels may not be the only cause of non‐compliance with standard mechanical ventilator guidelines. There is an urgent need to design and implement a program that can enhance and monitor the quality of nursing care provided to mechanically ventilated patients. Lastly, nurse staffing of ICUs in Pakistan must be increased to enable high quality care and more doctors should be trained in critical care. [ABSTRACT FROM AUTHOR]

Objectives: COVID-19 greatly disrupted the provision of emergency care across the globe. ED service delivery was urgently redesigned as human and material resources were mobilised, and patients with respiratory symptoms were isolated. This study aimed to compare ED patient volume and flow metrics before and during the COVID-19 pandemic. Methods: An observational study was conducted in two large urban EDs in Brisbane, Australia and Seoul, Republic of Korea. Patient volume and flow were quantified using ED presentation numbers and service times, respectively. Daily case numbers, waiting, treatment and admission delay times were compared between 2019 and 2020/2021 using time series plots. Outcomes were further classified by triage category and age group. Trends were examined alongside a timeline of health service and government policies. Results: There were reductions in daily presentations for the least urgent triage categories during the early phase of the pandemic. The caseloads for the most urgent triage categories were unaffected. The trends were similar in both EDs. A reduction in waiting and admission delay times but not treatment times coincided with reduced presentations in Brisbane. This pattern gradually reversed as presentations returned to baseline. In Seoul, admission delay times returned to pre-pandemic levels despite a persistent reduction in presentation numbers. Conclusions: Total daily presentations varied considerably according to government mandated social restrictions and testing requirements in both EDs. The reductions in waiting and admission delay times corresponded with improvements in hospital capacity. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID‐19 pandemic. Design: Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross‐sectional analysis, with application of a questionnaire. Setting: Six Brazilian Reference Centres on gestational trophoblastic disease. Population: 2662 patients with MP/postmolar GTN treated from March–December/2015–2020 were retrospectively evaluated and 528 of these patients answered a questionnaire. Methods: Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross‐sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID‐19 pandemic compared with previous years. Main outcome measures: The incidence of MP/postmolar GTN. Results: Compared with the last 5 pre‐pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID‐19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be >10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90–3.29, P < 0.001), have a pre‐evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38–2.28, P < 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01–3.43, P = 0.047) when compared with 2015–2019. Conclusions: Although the incidence of MP/postmolar GTN remained stable during the COVID‐19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Critics have charged that evidence‐based medicine (EBM) overemphasises algorithmic rules over unstructured clinical experience and intuition, but the role of structured decision support systems in improving health outcomes remains uncertain. We aim to assess if delivery of anticoagulant prophylaxis in hospitalised patients with COVID‐19 according to an algorithm based on evidence‐based clinical practice guideline (CPG) improved clinical outcomes compared with administration of anticoagulant treatment given at individual practitioners' discretion. Methods: An observational design consisting of the analysis of all acutely ill, consecutive patients (n = 1783) with confirmed COVID‐19 diagnosis admitted between 10 March 2020 to 11 January 2022 to an US academic center. American Society of Haematology CPG for anticoagulant prophylaxis in hospitalised patients with COVID‐19 was converted into a clinical pathway and translated into fast‐and‐frugal decision (FFT) tree ('algorithm'). We compared delivery of anticoagulant prophylaxis in hospitalised patients with COVID‐19 according to the FFT algorithm with administration of anticoagulant treatment given at individual practitioners' discretion. Results: In an adjusted analysis, using combination of Lasso (least absolute shrinkage and selection operator) and propensity score based weighting [augmented inverse‐probability weighting] statistical techniques controlling for cluster data, the algorithm did not reduce death, venous thromboembolism, or major bleeding, but helped avoid longer hospital stay [number of patients needed to be treated (NNT) = 40 (95% CI: 23–143), indicating that for every 40 patients (23–143) managed on FFT algorithm, one avoided staying in hospital longer than 10 days] and averted admission to intensive‐care unit (ICU) [NNT = 19 (95% CI: 13–40)]. All model's selected covariates were well balanced. The results remained robust to sensitivity analyses used to test the stability of the findings. Conclusions: When delivered using a structured FFT algorithm, CPG shortened the hospital stay and help avoided admission to ICU, but it did not affect other relevant outcomes. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 incidence is high in patients with cancer. The fatality rate was high for the Delta variant, necessitating infection prevention by vaccination. This study evaluated the safety of a SARS‐CoV‐2 vaccine in patients with advanced lung cancer receiving anticancer therapy. Methods: We prospectively enrolled patients receiving anticancer drugs for advanced lung cancer and planning SARS‐CoV‐2 vaccination. Early side effects within 7 days of vaccination were evaluated using patient‐reported outcome (PRO) surveys. Chi‐square test and multivariate logistic regression analyses were used. Results: Post‐vaccination PROs were collected from 406 patients (252 were males). The mean age was 72 years. Treatment at the time of initial vaccination included chemotherapy, immune checkpoint inhibitors (ICI), a combination of chemotherapy and ICI, targeted therapy including tyrosine kinase inhibitors, and others in 115, 93, 45, 147, and six cases, respectively. The vaccines administered were BNT162b2 and mRNA273 in 361 and three cases, respectively and unknown in 42 cases. A total of 16.1% of patients developed fever (38°C) after the second mRNA vaccination (95% confidence interval: 12.6%–20.1%). This rate is comparable to data previously reported in 120 patients and slightly higher than that of healthy participants of the BNT162b2 study. Patients receiving treatment with cytotoxic anticancer agents were more likely to have high fever. Multivariate analysis showed no correlation between fever frequency and patient background. No serious initial adverse events due to vaccination were observed. Conclusions: Anti‐SARS‐CoV‐2 mRNA vaccination is safe; however, post‐vaccination fever is more common in patients undergoing lung cancer treatment than in healthy individuals. [ABSTRACT FROM AUTHOR]

Objective: Investigate medical morbidity and risk of general hospital admission for patients with concurrent coronavirus disease 2019 (COVID‐19) and anorexia nervosa (AN) who have not received severe acute respiratory syndrome coronavirus 2 vaccination. Methods: United Kingdom eating disorders clinicians contributed to a database of patients with an eating disorder and COVID‐19. We used this to investigate demography, symptoms, hospitalization, treatment, and outcomes for those with AN. Results: We describe data for 49 patients (median age 21.5 years [interquartile range 17.0–33.5], 46 female) including 36 adults and 13 under‐18‐year‐olds. Three (6.1% [95% confidence interval 1.3%–17.9]) were admitted to a general hospital. For this sample, the expected age‐standardized hospital admission rate per COVID‐19 case (based on the general population of England) was 2.6% and therefore not significantly different to the hospitalization rate we observed. Three (including two of those admitted to hospital) contracted pneumonia. One had severe pneumonia and was admitted to an intensive care unit. No deaths or use of mechanical ventilation were recorded. Discussion: To our knowledge, this represents the first study investigating medical morbidity or frequency of hospitalization for patients with COVID‐19 and AN. We did not find evidence that patients with AN are at increased risk of severe COVID‐19. Public Significance: Medical morbidity and risk of hospitalization associated with concurrent COVID‐19 and anorexia nervosa (AN) had not, to our knowledge, been studied before. We used a database of patients with eating disorders and COVID‐19 (to which United Kingdom clinicians had contributed) to investigate presentation, treatment, outcomes, and COVID‐19 severity for those with AN and COVID‐19. We did not find evidence that patients with AN are at increased risk of severe COVID‐19. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was (1) to examine sleep changes in first graders before and after school closure and (2) to examine the association between parental work rearrangement and children's sleep change during the coronavirus disease 2019 (COVID‐19) pandemic. Design and Methods: This was an observational study. The children's sleep habit questionnaire was completed by 103 parents of first‐graders before and after school closure. Paired t‐test and the general linear model were applied to data analysis. Results: Children delayed their bedtime and rising time, but total sleep duration increased. Moreover, parents who rearranged their work during the pandemic perceived more child parasomnia symptoms (p =.029) and less delayed sleep‐wake patterns in their children. Practical Implication: Sleep is an indicator that reflects children's behavioral changes in response to the COVID‐19 pandemic. As routine changes, parents should be aware of child's parasomnia symptoms. Nursing interventions could aim at promoting sufficient external cues in the daytime during home confinement. [ABSTRACT FROM AUTHOR]

Nitrous oxide is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID‐19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. We aimed to determine the impact of withholding nitrous oxide for labour analgesia, during the COVID‐19 pandemic, on epidural rates, opioid analgesia use, and maternal and neonatal outcomes. Withholding nitrous oxide for labour analgesia did not alter epidural rates but did significantly increase opioid analgesia use. Caesarean section rates, post‐partum blood loss and neonatal APGAR scores did not change. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries among frontline health care workers wearing personal protective equipment (PPE) during the COVID‐19 pandemic. This was a mixed methods study. First, a pre‐posttest observational design was employed to evaluate the impact of the pre‐piloted intervention, a care bundle including skin cleansing and hydration, protective material use, facemask selection and skin inspection, developed in line with international best practice guidelines. Data were collected using survey methodology. Frontline COVID‐19 staff working in acute, community and ambulance services were invited to participate. Then, judgemental and volunteer sampling was used to select participants to undertake semi‐structured interviews to elicit feedback on their perceptions of the care bundle. The sample included 120 acute hospital staff, 60 Ambulance staff, 24 Community Hub staff and 20 COVID‐19 testing centre staff. A survey response rate of 61% was realised (n = 135/224). Of the participants, 32% (n = 43) had a facial pressure ulcer (FPI) pre‐intervention and 13% (n = 18) developed an FPI while using the care bundle. The odds ratio (OR) was 0.33 (95% CI: 0.18 to 0.61; P =.0004), indicating a 77% reduction in the odds of FPI development with use of the care bundle. Analysis of the qualitative data from 22 interviews identified three key themes, the context for the care bundle, the ease of use of the care bundle and the care bundle as a solution to FPI development. The care bundle reduced the incidence of FPI among the participants and was found to be easy to use. Implementation of skin protection for frontline staff continues to be important given the persistently high incidence of COVID‐19 and the ongoing need to wear PPE for protracted durations. [ABSTRACT FROM AUTHOR]

Background: The objective of this systematic review is to investigate changes in the epidemiology of major trauma presentations during the implementation of movement restriction measures to manage the first wave of the SARS-CoV-2 (COVID-19) pandemic. Methods: A systematic search in six databases, as well as a search of grey literature was performed from January 2020 to August 2021. Estimates were pooled using random-effects meta-analysis. The certainty of evidence was rated according to the GRADE approach. The review is reported using both PRISMA guideline and the MOOSE checklist. Results: In total, 35 studies involving 36,987 patients were included. The number of major trauma admissions overall decreased during social movement restrictions (−24%; p < 0.01; 95% CI [−0.31; −0.17]). A pooled analysis reported no evidence of a change in the severity of trauma admissions (OR:1.17; 95%CI [0.77, 1.79], I2 = 77%). There was no evidence for a change in mortality during the COVID-19 period (OR:0.94, 95%CI [0.80,1.11], I2 = 53%). There was a statistically significant reduction in motor vehicle trauma (OR:0.70; 95%CI [0.61, 0.81], I2 = 91%) and a statistically significant increase in admissions due to firearms and gunshot wounds (OR:1.34; 95%CI [1.11, 1.61], I2 = 73%) and suicide attempts and self-harm (OR:1.41; 95%CI [1.05, 1.89], I2 = 39%). Conclusions and relevance: Although evidence continues to emerge, this systematic review reports some decrease in absolute major trauma volume with unchanged severity and mortality during the first wave of COVID-19 movement restriction policies. Current evidence does not support the reallocation of highly specialised trauma professionals and trauma resources. Registration PROSPERO ID CRD42020224827. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has necessitated alterations in provision of health care and how patients access it. Telehealth has replaced traditional face‐to‐face outpatient clinics in an unprecedented manner. This study aimed to assess overall patient and clinician satisfaction with telehealth consultations, to establish acceptability of telehealth during pandemic and non‐pandemic times, and document feedback. Materials and Methods: A prospective observational study involving women presenting to a general gynaecology outpatient department was performed. Women who attended for consultation between 13 July and 4 September 2020 were invited to participate in a questionnaire following their telehealth appointment. Clinicians consulting in the outpatient department were invited to complete a questionnaire at the end of the eight‐week study period. Satisfaction, utility and acceptability data were obtained using visual analogue scales (VAS). Results: Twenty‐six out of 56 (46.4%) clinicians and 124/870 (14.3%) patients completed the questionnaire. Patients who responded were older and more likely to have been born in Australia than women who did not (P = 0.0355 and P = 0.005, respectively). Overall patient satisfaction with telehealth was high (median VAS (interquartile range), 8.6 (5.6–9.8)). More women found telehealth to be acceptable during a pandemic than afterward (8.9 vs 6.6, P < 0.0001). Clinicians were less satisfied with telehealth than patients (7.1 vs 8.6, P = 0.02); however, most would be happy to continue using telehealth in non‐pandemic times (7.0 (6.2–9.8)). Conclusion: Telehealth consultations allow provision of gynaecological care at a time when reducing risk of infection to patients and staff is paramount. Telehealth gynaecology consultations are efficient and convenient without significant detriment to patient or clinician satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To understand communities' perceptions, beliefs, and health‐related behavior choices related to COVID‐19 in order to guide public health nursing communication and interaction with patients and the community. Design: A qualitative study, guided by the Health Belief Model (HBM), strove to comprehend the perceptions and reactions to COVID‐19 among Wisconsinites. Sample: Twenty‐five diverse Wisconsin residents aged 18 or older. Measurements: Semi‐structured interviews provided information about individuals' attitudes, perceptions, and reactions to COVID‐19. Interviews were audio‐recorded, transcribed, and thematic analysis was conducted to identify themes. Results: We identified three major themes: (1) "health care starts way before you ever enter the doors of a healthcare facility"; (2) "to live in a society is to help each other"; and (3) mental health as impacted by COVID‐19. Conclusions: This study demonstrated the need for greater public health support, as well as the role of Social Determinants of Health. Understanding perceptions and reactions to COVID‐19 can help public health nurses understand and better respond to future pandemics. [ABSTRACT FROM AUTHOR]

Issues Numerous studies have examined the impact of the COVID‐19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms. Approach: We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self‐reported changes in alcohol use associated with COVID‐19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random‐effects meta‐analyses of proportional differences in alcohol use changes. Variations by time, sub‐region and study quality were assessed in subsequent meta‐regressions. Additional 16 reports identified were summarised narratively. Key Findings: Compiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00–7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7–13.2%), quantity consumed (12.2%, 95% CI 8.3–16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6–21.8%). Among people with pre‐existing high drinking levels/alcohol use disorder, high‐level drinking patterns appear to have solidified or intensified. Implications: Pandemic‐related changes in alcohol use may be associated with pre‐pandemic drinking levels. Increases among high‐risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health‐care services. Conclusion: Our findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high‐quality studies examining specific change mechanisms at the population level are lacking. [ABSTRACT FROM AUTHOR]

This study aimed to assess (i) COVID‐19 transmission prior to and following spectator events and (ii) methodological approaches to capturing event‐related transmission during the spectator return. Local authority population transmission rates were used to identify higher transmission areas, which were excluded from participant attendance following registration. Using observational online and SMS questionnaires, self‐reported COVID‐19 diagnoses (positive tests) and racing‐related NHS Test and Trace contacts within 14 days of spectating were reported for two British Horseracing events and three Point to Point (PTP) grassroots races. There were 1,477 registrations for the British Horseracing events, and 1,678 registrations for PTP races. Responses were received from 464 attendees of British Horseracing events (31.4% response rate). Two attendees reported a COVID‐19 diagnosis, and no attendees reported NHS Test and Trace contact. From PTP races, 862 attendees (51.3%) consented to receive the SMS survey, and responses were received from 495 attendees (57.4% response rate). Five attendees reported positive COVID‐19 diagnoses, and two attendees reported being contacted by NHS Test and Trace, of which one was following a non‐racing potential COVID‐19 exposure. There was limited evidence of COVID‐19 transmission at outdoor elite and grassroots level horseracing events during autumn 2020. A higher response rate was received with SMS surveys; however, there was a reluctancy to "opt in" to SMS methodology. This study describes different methodological approaches to monitoring COVID‐19 transmission risk at events, which may have relevance for other sporting and event contexts during the current pandemic, and sustained attendances during periods with circulating transmissible diseases. [ABSTRACT FROM AUTHOR]

Summary: Coagulation dysfunction and thrombosis are major complications in patients with coronavirus disease 2019 (COVID‐19). Patients on oral anticoagulants (OAC) prior to diagnosis of COVID‐19 may therefore have better outcomes. In this multicentre observational study of 5 883 patients (≥18 years) admitted to 26 UK hospitals between 1 April 2020 and 31 July 2020, overall mortality was 29·2%. Incidences of thrombosis, major bleeding (MB) and multiorgan failure (MOF) were 5·4%, 1·7% and 3·3% respectively. The presence of thrombosis, MB, or MOF was associated with a 1·8, 4·5 or 5·9‐fold increased risk of dying, respectively. Of the 5 883 patients studied, 83·6% (n = 4 920) were not on OAC and 16·4% (n = 963) were taking OAC at the time of admission. There was no difference in mortality between patients on OAC vs no OAC prior to admission when compared in an adjusted multivariate analysis [hazard ratio (HR) 1·05, 95% confidence interval (CI) 0·93–1·19; P = 0·15] or in an adjusted propensity score analysis (HR 0·92 95% CI 0·58–1·450; P = 0·18). In multivariate and adjusted propensity score analyses, the only significant association of no anticoagulation prior to diagnosis of COVID‐19 was admission to the Intensive‐Care Unit (ICU) (HR 1·98, 95% CI 1·37–2·85). Thrombosis, MB, and MOF were associated with higher mortality. Our results indicate that patients may have benefit from prior OAC use, especially reduced admission to ICU, without any increase in bleeding. [ABSTRACT FROM AUTHOR]

Objectives: The study investigates the impact of COVID‐19 on dental hygiene professionals practising in Saudi Arabia, and measuring the knowledge and preparedness of dental hygienists to provide care during the pandemic. Methods: A non‐experimental, cross‐sectional study was conducted targeting dental hygiene professionals in Saudi Arabia. The online survey consisted of 31 close‐ended questions: 9‐items related to demographics, and 22‐items that are COVID‐19 related. Data were tested at two levels; descriptive and preliminary using Chi‐square test, and significance was set at the 0.05 level. Results: One hundred and thirty‐one responses were received and the final sample included one hundred and eighteen responses as it excluded unemployed dental hygienists with estimated 39.6% response rate. The stress level to return to practice was considered moderate among 65.3% of participants. Over two‐thirds (73.7%) of dental hygienists were not providing any kind of care/treatment during quarantine. Generally, a moderate level of knowledge (57.8%) was demonstrated by participants. For preparedness level to practice during the pandemic, sixty‐four dental hygienists (54.2%) were adequately prepared to provide care. Significant correlations were found between impact and knowledge (p = 0.045), impact and preparedness (p = 0.053), and knowledge and preparedness (p = 0.024). Conclusions: Dissemination of COVID‐19 protocols, guidelines and scientific literature increased the respondents' level of knowledge and preparedness to an adequate level. This study indicated that knowledgeable dental hygienists were significantly more prepared to treat patients during the pandemic and that stress positively influenced the COVID‐19 knowledge acquisition. Non‐practising dental hygienists during quarantine were more knowledgeable and more prepared to practice during the pandemic. [ABSTRACT FROM AUTHOR]

Objective: This study seeks to evaluate the test characteristics of D‐dimer for pulmonary embolism (PE) in patients with a concurrent diagnosis of COVID‐19. We hypothesized that the sensitivity of D‐dimer for PE at current institutional cut points would be similar to those without COVID‐19. Methods: This is a multicenter retrospective observational cohort study across five urban and suburban EDs in the same health care system. The electronic health record was queried for all computed tomography pulmonary angiography (CTPA) studies from December 1, 2019, to October 22, 2020. All ED patients who underwent CTPA had D‐dimer and COVID‐19 testing completed in a single encounter were included in the study. Baseline demographics were obtained. Test characteristics of D‐dimer for PE were calculated for patients with and without COVID‐19. Additionally, receiver operator characteristics (ROC) curves were constructed for two different D‐dimer assays. Results: There were 1158 patient encounters that met criteria for analysis. Performance of D‐dimer testing for PE was similar between COVID‐19–positive and –negative patients. In COVID‐19–positive patients, the sensitivity was 100% (95% confidence interval [CI] = 87.6%–100%), specificity was 11.9% (95% CI = 7.9%–17.1%), and negative predictive value (NPV) was 100%. In COVID‐19–negative patients the sensitivity was 97.6% (95% CI = 91.5%–99.7%), specificity was 14.4% (95% CI = 12.1%–17%), and NPV was 98.3% (95% CI = 93.8%–99.6%). For assay 1 the area under the curve (AUC) for COVID‐19–positive patients was 0.76 (95% CI = 0.68–0.83), and for COVID‐19–negative patients, 0.73 (95% CI = 0.69–0.77). For assay 2, AUC for COVID‐19–positive patients was 0.85 (95% CI = 0.77–0.92), and for COVID‐19–negative patients, 0.80 (95% CI = 0.77–0.84). Inspection of the ROC curve for assay 1 revealed that 100% sensitivity was maintained up to a threshold of 0.67 FEU (fibrinogen equivalent units; from 0.50 FEU) with an increase in specificity to 29% (from 18.7%), and for assay 2, 100% sensitivity was maintained up to a threshold of 662 D‐dimer units (DDU; from 230 DDU) with an increased specificity to 59% (from 6.1%). Conclusion: Results from this multicenter retrospective study did not find a significant difference in sensitivity of D‐dimer for PE due to concomitant COVID‐19 infection. Further study is required to determine if PE can safely be excluded based on D‐dimer results alone in patients with suspected or proven COVID‐19 or if adjusted D‐dimer levels could have a role in management. [ABSTRACT FROM AUTHOR]

The article reports their experience of patients with oral lichen planus (LP), mucous membrane pemphigoid (MMP), and pemphigus vulgaris (PV), recovered from COVID-19 to detail any possible changes in oral manifestation after the recovery and compare those data with patients with oral autoimmune disease (AD), who did not experience COVID-19. Topics include basis of the diagnosis of COVID-19, finding on patients diagnosed with systemic autoimmune diseases, and speculation on SARS-COV-2 infection.